Managing Gut and Bladder Problems

Some of the most common non-motor symptoms of Parkinson’s are issues with digestion and elimination. Constipation is encountered by at least half of all people with Parkinson’s, sometimes decades before the onset of motor symptoms, or later as a side effect to drugs like levodopa. Additionally, about one third of people with Parkinson’s will develop incontinence. Although these issues are often considered mere nuisances, they can cause significant pain, discomfort and complications if left unmanaged.

The best way to treat elimination issues is by maintaining healthy everyday habits. As with any other symptoms of Parkinson’s, digestion and continence issues may not be experienced by everyone and can differ greatly between individuals. Regardless of whether or not you have encountered these issues, it is important to recognize warning signs and be prepared to treat any new symptoms accordingly. Below is a guide to some of the simple lifestyle changes you can adopt to prevent and treat constipation and incontinence.

Constipation

A healthy gut can pass stool anywhere from three times per day to three times per week, while each meal can take anywhere from 12-72 hours to digest. Constipation is diagnosed when fewer than three bowel movements occur weekly, at which point stool remains in the intestines long enough that it becomes too dry and lumpy to pass comfortably. Other signs of constipation include sensations of rectal obstruction and fullness, or incomplete passing of stool during bowel movements (GI Society, 2017).

Bowel pattern changes occur in people with Parkinson’s as a result of improper nerve functioning in the gut, which can slow the passing of stool. These issues can also worsen due to the presence of other common PD symptoms, including dehydration, lack of exercise, poor diet and stress. In order to alleviate constipation, it is important to treat these symptoms first.

Constipation can most effectively be managed by adopting a high-fibre diet, along with maintaining adequate fluid intake and exercise levels. Fibre helps to bulk and soften stool, making it easier to pass. Health Canada recommends eating 25-38 grams of fibre daily, but reports that most Canadians eat only half that much (Health Canada, 2012). This is likely due to the favouring of quick, easy food products packed with sugar and fats. Adding more fibre to your diet can be as simple as using alternatives to some of these everyday foods, including:

• whole wheat and bran to replace refined grains in breads and crackers
• brown rice or quinoa to replace white rice
• whole grain pastas to replace white pasta
• oatmeal to replace sugary cereals

Along with these grain products, you should increase your intake of legumes, nuts, seeds and fruits and vegetables with skin. Some more fibre-rich foods you can add to your grocery list include: apples, avocado, bananas, berries, broccoli, cauliflower, corn, oranges, pears, peas, potato, raisins and spinach. Keep in mind the rule that the darker and richer the colour, the higher in fibre the food.

Dietary fibre should be increased slowly to reduce bloating, cramping and gas. Exercise can help lessen these side effects and promote bowel movements. An adequate fluid intake is also important to ensure proper digestion of fibre and regularity. People with Parkinson’s should look to drink six to eight 250mL glasses of water daily. To help with constipation, warm liquids like herbal teas can help with bowel movements, especially in the morning (Michael J. Fox Foundation). However, caffeinated beverages, alcohol and hot liquids can lead to dehydration and should be limited.

If problems persist beyond these dietary changes, speak to your doctor about fibre supplements and aids for constipation. Do not turn to laxatives without doctor’s supervision, as these may damage the lining of the colon, which only serves to worsen constipation (Parkinson’s Disease Clinic).

Incontinence

Many people with Parkinson’s will develop incontinence, which can cause sensations of urgency commonly occurring during the night. This nighttime hyperactivity, referred to as Nocturia, is among the most common non-motor symptoms reported by people with Parkinson’s. Nocturia not only disrupts sleep, but increases risk of falls and injury in navigating trips to the restroom in the dark. Other incontinence problems include increased frequency of urination, leakages and the inability to completely empty the bladder.

Though many Parkinson’s medications can lead to constipation, they are also known to help with incontinence. Control of the bladder is linked to the body’s dopamine levels, so many people experience the worst of their incontinence symptoms during the times of day when medication wears off between doses. Taking medication on time every time can help continence significantly (Continence Foundation Australia, 2014).

Many people with incontinence may look to decrease their fluid intake in order to control symptoms, but this is counterproductive as it can lead to dehydration. Instead, incontinence is best managed by drinking enough water while decreasing intake of bladder irritants such as: caffeine, coffee (even decaffeinated), alcohol, artificial sweeteners, dairy products, citrus juices, carbonated beverages, chocolate, honey and spicy foods (NAFC, 2017). No diet can guarantee a cure for incontinence, but healthy eating can help regulate the body’s elimination patterns and schedule.

Constipation and incontinence can often occur at the same time, but the maintenance of healthy habits such as drinking enough water and “honouring the urge” to pass stool or urinate can have a profound effect on both conditions. If these smaller, everyday changes are not enough to help your bowel or bladder problems, consult a physician before attempting further treatments.

Sources

Canadian Society of Gastrointestinal Research. (2017). Constipation Overview. Retrieved from https://www.badgut.org/information-centre/a-z-digestive-topics/constipation/

Health Canada. (2012). Do Canadian Adults Meet Their Nutrient Requirements Through Food Intake Alone? Retrieved from http://bit.ly/2IRInwV

Dolhun, Rachel. (2017). Ask the MD: Constipation and Parkinson’s. Retrieved from http://bit.ly/2Nnfv2R

Parkinson’s Disease Clinic and Research Center. Constipation and Dietary Needs. Retrieved from http://pdcenter.neurology.ucsf.edu/patients-guide/constipation-and-dietary-needs

National Association for Continence. Bladder Irritants. Retrieved from https://www.nafc.org/bladderirritants/

Continence Foundation of Australia. Parkinson’s Disease. Retrieved from https://www.continence.org.au/pages/parkinsons-disease.html 

This content was published in the Fall 2018 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.